The Importance of Gender Affirming Care for Youth

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Although Pride month has come to an end, it is imperative that we continue the conversations about the importance of supporting gender affirming health care for youth. Passed and pending legislation have the ability to significantly impact the health care of people who are experiencing gender dysphoria, specifically transgender and gender-diverse individuals. The Association of American Medical Colleges discusses gender affirming care as “interventions [that] help trangender people align various aspects of their lives- emotional, interpersonal, and biological- with their gender identity” (1). These interventions widely vary and can include both social and medical interventions; however, it is important to note that surgical interventions are rarely provided for youth under 18 years of age (1).

In the United States (US), an estimated 300,000 youth (1.4% of the population) between the ages of 13 and 17 identify as transgender (2). Youth seeking gender affirming services are more likely to have increased rates of mental health concerns, such as depression and anxiety, compared to youth not seeking gender affirming care (3). However, youth who are provided with gender affirming care, specifically puberty blockers and hormone therapy, have a lower prevalence of moderate to severe depression, self-harm, and suicidality after starting the gender affirming care (4,5)

Individuals against the use of gender affirming health care for youth frequently argue that gender affirming care cannot be reversed; however, this belief is mostly incorrect and is refuted by multiple pieces of evidence. The majority of gender affirming care options available to youth are reversible, including social affirmation and puberty blockers. Less-frequently available options, such as hormone therapy, do cause some permanent changes within the body (6,7,8). Surgical gender affirming care options are rarely used among the youth population (6). Additionally, the majority of youth who receive gender affirming care (92.7%) do not report detransitioning or wanting to reverse their gender affirming care within a five year period after their care began (9).

Despite the proven necessity of gender affirming care for youth, this care is currently under attack in the US. Of the approximately 520 anti-LGBTQ+ bills that have been passed in the US in 2023, over 220 of these bills are specifically directed towards transgender and gender-nonconforming individuals (10). According to data through the end of March 2023, 30 states have either restricted or have considered restricting access to gender affirming care for youth, impacting or potentially impacting the health care of approximately 146,300 transgender youth across the US (11,12). Pending legislation in 19 of these states can result in 68,400 transgender youth losing their ability to access gender affirming health care (11)

The specific details around the bans on gender affirming care vary across states and  include the potential for being charged with a felony for providing certain care in five different states (13). Legislation goes into effect this month in Iowa, Mississippi, and Indiana that specifically makes it illegal for individuals to assist minors in receiving gender affirming care (13). Additionally, Texas Attorney General, Ken Paxton, even declared that prescribing puberty blockers for youth is considered “child abuse” under Texas Law (14)

These laws are just part of the current social climate that is impacting LGBTQ+ folks across the US. In addition to the current legislation, providers and hospitals offering gender affirming care to youth are seeing an increase in violent threats and harassment (15). FBI data from 2021 show that approximately 20% of hate crimes committed in the US are “motivated by anti-LGBTQ+ bias” (16).

With the threat of an increasing amount of legislation banning gender affirming care for youth in the US, is it important now more than ever to make sure you vote for your local, state, and federal lawmakers. It is also important for us as health equity researchers and social justice advocates to share facts about gender-affirming care and elevate the voices of transgender people whenever we can. The facts show us that gender affirming care provides transgender and gender-diverse youth with needed health care options, but also provides a foundation for a life of safety, acceptance, and the chance to live an authentic life. This should be our goal for all young people in our country, and as health care and public health professionals we must all work together to achieve it. 

  1. https://www.aamc.org/news/what-gender-affirming-care-your-questions-answered
  2. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-Pop-Update-Jun-2022.pdf
  3. https://journals.lww.com/jrnldbp/Abstract/2019/11000/Baseline_Mental_Health_and_Psychosocial.3.aspx
  4. https://pubmed.ncbi.nlm.nih.gov/35212746/
  5. https://www.sciencedirect.com/science/article/abs/pii/S174360951534443X
  6. https://opa.hhs.gov/sites/default/files/2022-03/gender-affirming-care-young-people-march-2022.pdf
  7. https://my.clevelandclinic.org/health/treatments/22322-masculinizing-hormone-therapy
  8. https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy#:~:text=Many%20of%20the%20effects%20of,absent%20fertility%20are%20not%20reversible.
  9. https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition?autologincheck=redirected
  10. https://www.hrc.org/press-releases/roundup-of-anti-lgbtq-legislation-advancing-in-states-across-the-country
  11. https://williamsinstitute.law.ucla.edu/publications/bans-trans-youth-health-care/ 
  12. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-Youth-Health-Bans-Mar-2023.pdf
  13. https://www.cnn.com/2023/06/06/politics/states-banned-medical-transitioning-for-transgender-youth-dg/index.html
  14. https://www.texasattorneygeneral.gov/news/releases/ag-paxton-declares-so-called-sex-change-procedures-children-and-prescription-puberty-blockers-be
  15. https://www.politico.com/news/2023/04/23/docs-who-treat-trans-youth-under-attack-00093322
  16. https://cde.ucr.cjis.gov/LATEST/webapp/#/pages/explorer/crime/hate-crime

Jordan Kron, MPH

Research Associate